Oxygen Therapy Elola Maberry, MSN, RN Oxygen is one of the most important elements required to sustain life. Without it, our health begins to suffer and/or we die.

Health History Describe your usual activities for a 24-hour period. Do you become short of breath or very tired with certain activities? Explain. How many flights of stairs can you climb before you begin to have difficulty breathing? Are your activities interrupted by frequent coughing? If so, describe the frequency and type of cough. Do you cough up phlegm or mucus? If so, describe its amount, color, odor, and the presence of blood. Has your ability to care for yourself changed with this respiratory problem? Explain. What type of exercise do you usually do? Has this changed? Describe.

Physical Assessment Focus Order Findings Abnormal Breathing Patterns Hypoxia Abnormal Hgb Focus- perform respiratory assessment Order- must have an order for oxygen

Nursing Diagnosis Activity Intolerance Fatigue Ineffective airway clearance Ineffective breathing pattern Activity intolerance

Nursing Responsibilities Monitoring Oxygen Which kind? Medication Administration Inhaler Nebulizers Monitoring– frequent checks (q2h) should be made and recorded in the client’s chart. MUST INCLUDE– heart rate, respiratory rate, work of breathing (descriptive assessment—i.e. use of accessory muscles/nasal flaring) Oxygen saturation level, and Level of consciousness. Inhalers Nebulizers

Selection of Oxygen Oxygen delivery method selected depends on: •age of the patient •oxygen requirements/therapeutic goals •patient tolerance to selected interface •humidification needs

Sources of Oxygen Wall unit Flow meter Christmas tree

Oxygen Flow Rate The flow rate of oxygen is measured in liters per minute. The rate depends on the condition of the patient and the route of administration of the oxygen. The physician’s order prescribes the rate of oxygen administration. Example: Oxygen @ 3L/min per nasal cannula.

Humidification Oxygen dries and dehydrates the respiratory mucous membranes. Distilled or sterile water is commonly used to humidify oxygen and prevent the airway from drying.

Precautions for Oxygen Administration Avoid open flames in the patient’s room. Place “no smoking” signs in home. Instruct the patient and visitor’s about the hazard of smoking when oxygen is in use. Check to see that electrical equipment used in the room, such as electric bell cords, razors, radios, and suctioning equipment, is in working order and emits no sparks. Avoid wearing and using synthetic fabrics that build up static electricity. Avoid using oils in the area. Oil can ignite spontaneously in the presence of oxygen.

Oxygen Delivery Systems Nasal cannula Simple mask Partial non-rebreather mask Nonrebreather Venturi mask Oxygen tent

Nasal Cannula Most commonly used oxygen delivery device. A disposable plastic device with two protruding prongs that are inserted into the nostrils. It is connected to an oxygen source with a flow meter, and many times, a humidifier. Does not imped eating or speaking. Easily used at home. Disadvantages: Can be dislodged easily and can cause dryness of the nasal mucosa. If client has Chronic Obstructive Pulmonary Disease (COPD), do not exceed oxygen over 2-3L/min per nasal cannula. Note: when you assess the patient, make sure both prongs are in.

NASAL CANNULA

Face Masks Mask is fitted carefully to the patient’s face to avoid leakage of oxygen. (comfortably snug but not tight)

Simple Face Mask Connected to oxygen tubing, a humidifier, and a flow meter. Has vents on its sides that allow room air to leak in at many places, thereby diluting the source of oxygen. The vents allow exhaled carbon dioxide to escape. Used when an increased delivery of oxygen is needed for short periods (less than 12 hours). Skin breakdown is a possibility Eating and talking with the mask in place can be difficult. Never apply the simple face mask with a delivery flow rate of less than 5 liters per minute.

Nonrebreather Mask Delivers the highest concentration of oxygen via a mask to a spontaneously breathing patient. Two one-way valves prevent the patient from rebreathing exhaled air. The reservoir bag is filled with oxygen that enters the mask on inspiration. Exhaled air escapes through side vents. A malfunction of the bag could cause carbon dioxide buildup and suffocation. Can be used to administer other gases, such as heliox.

Nonrebreather mask

Venturi Mask Allows the mask to deliver the most precise concentrations of oxygen. The mask has a large tube with an oxygen inlet, causing the air to be pulled in through side ports. These ports are adjusted according to the prescription for oxygen concentration.

Oxygen Tent A light, portable structure made of clear plastic and attached to a motor-driven unit. Thermostat keeps the tent at comfortable temperature Fits over the top part of the bed; has side openings through which nursing care can be administered. Commonly used with children who need a cool and highly humidified airflow.

Oxygen tent

Oxygen Therapy in the Home Liquid oxygen and oxygen concentrators are used more commonly in the home setting. Liquid oxygen is kept inside a small thermal container that can be refilled from a larger storage tank kept in the home. Oxygen concentrators are portable, cost-effective, and easy to use but cannot deliver oxygen flow at greater than 4L/min.

***Oxygen is a combustible gas; a spark may ignite the oxygen***. Teaching Tips NO smoking or open flames are allowed with 10 feet of the oxygen source. Do not use electrical equipment near oxygen administration set. Use caution with gas or electric appliances. Ground oxygen concentrators. Secure the oxygen tank in a holder and away from direct sunlight or heat. Allow adequate airflow around the oxygen concentrator. Notify local fire department of the oxygen in the home. ***Oxygen is a combustible gas; a spark may ignite the oxygen***.

Oxygen Administration Follow the physician’s order for the oxygen flow rate. Have the physician’s and nurse’s phone number readily available. Ensure enough available oxygen prior to leaving house for errands or trips. Know how to reach the oxygen equipment vendor and the reasons for contacting the vendor. Know signs and symptoms that indicate the need to call for emergency assistance. ***Too much or too little oxygen may be detrimental to the patient***

Pulse Oximetry Noninvasive technique that measures the arterial oxyhemoglobin saturation of arterial blood. Useful for monitoring patients receiving oxygen therapy, titrating oxygen therapy, monitoring those at risk for hypoxia, and monitoring postoperative patients. Does not replace arterial blood gas analysis. Desaturation indicates gas exchange abnormalities. Be aware of the patient’s hemoglobin level before evaluation the oxygen saturation. 95%-100% is considered normal. Lower indicates oxygenation to the tissues is inadequate.

Pulse Oximeter

Fingernail Polish and Pulse Oximetry Fingers are the first choice of site for this measurement. 2nd choice – ear lobe